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The Wicked Issue of Health Inequalities

The Wicked Issue of Health Inequalities. Professor David Hunter. For every complex problem, there is an answer that is clear, simple and wrong H L Mencken (1880-1956). Failure of Policies and Systems: Why?. Lack of political will – vested interests in maintaining status quo

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The Wicked Issue of Health Inequalities

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  1. The Wicked Issue of Health Inequalities Professor David Hunter

  2. For every complex problem, there is an answer that is clear, simple and wrong H L Mencken (1880-1956)

  3. Failure of Policies and Systems: Why? • Lack of political will – vested interests in maintaining status quo • Policy incoherence – push and pull in different directions • Systems and structures not ‘fit for purpose’ • Bias towards downstream interventions – ‘lifestyle drift’ • Lack of capability and capacity to tackle to complex wicked issues

  4. Paradigm Shift • Acknowledge existence of ‘wicked issues’ • Value of a systems approach

  5. Defining Features of Wicked Issues (1) • Difficult to define – no definite formulation • Continually evolve and mutate • Multiple causes • Interdependent • Cross-governmental • Conflicting goals

  6. Defining Features of Wicked Issues (2) • Solutions may have unforeseen consequences • Unstable • Socially complex • Solutions are better or worse, not right or wrong • Context is all-important

  7. Complex Adaptive System A collection of individual agents with freedom to act in ways that are not always totally predictable, and whose actions are interconnected so that one agent’s actions changes the context for other agents. Plsek and Greenhalgh (2001), BMJ

  8. The Complex Adaptive Leader • Manages context and relationships • Creates conditions that favour emergence and self-organisation • Let’s go of ‘figuring it all out’ • Works with simple rules – good enough information and minimum specifications • Launches many diverse experiments, reflects on what is happening, instead of trying to figure out the ‘one best way’ • Works with natural attractors and flows rather than always relying on formal structures

  9. Wicked Issues and Performance Assessment: The case of health inequalities • A comparative study of England, Scotland and Wales • Research teams from Durham, Aberdeen and Cardiff universities

  10. Constructing Health Inequality • Health inequalities were widely seen in all countries as caused by deprivation • Focus in England on ‘quick wins’ driven by performance assessment and availability of models for secondary prevention • Target-driven culture absent from Scotland and Wales • In Scotland, focus on joined-up government approach to health inequalities • In Wales, no driver for focus on health inequalities

  11. Is Scotland Showing the Way Forward? Recognition of the need To continue breaking down organisational barriers and encourage working across departmental silos in order to achieve overarching objectives. Taking Stock review (2006)

  12. The Scottish Executive …has emphasised the maintenance of a unified corporate identity. This has also been promulgated through the matching of ministers to topics that cross departments, rather than identifying ministers clearly with specific departments. IPPR, Innovations in Government (2007)

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